P3D260: Evaluating Outcomes of Non-accidental Trauma in Military Children

Background: Non-accidental trauma (NAT), or child abuse, is a leading cause of childhood traumatic injury and death in the United States. Studies have shown that individuals with military affiliations are at greater risk of mental health complications and family violence including intimate partner violence and child maltreatment. There is a dearth of information pertaining to the outcomes of military children who experience NAT. This study aims to compare the difference in outcomes between military-dependent and civilian pediatric patients who are diagnosed with NAT.

Methods: A single institution retrospective review was performed of admitted pediatric patients < 18 years old with confirmed cases of NAT between 2008 and 2021 at a Level I trauma center. Data was collected from the Trauma Center registry and a database prospectively maintained by the hospital’s Child Abuse Team. Cases of self-inflicted harm, neglect, and sexual abuse were excluded.

Military affiliation was identified using insurance status and parental or caregiver self-reported active-duty military status. Demographic and clinical data including hospital length of stay (LOS), medical complications related to the patient encounter, hospital consults received, and mortality was compared between military and non-military affiliated patients. Kruskal-Wallis 1-way ANOVA was conducted to compare means and Chi-square tests was used to compare categorical variables. A p-value < 0.05 was considered statistically significant.

Results: Among 535 patients who experienced NAT, 11.8% (n=63) were affiliated with the military. The median age of the overall cohort was 6 months (IQR 2-15). The median age of military-associated patients, 3 months (IQR 1-7), was significantly younger than civilian patients, 7 months (IQR 3-18, p<.001). There were no significant differences in gender distribution. Compared to civilian children, military-affiliated patients had a longer LOS of 4 days (IQR 2-11) vs 2 days (IQR 1-7, p< 0.05), increased number of complications (3 counts vs 2 counts, p< 0.05), and a higher mortality rate (10% vs 4%, p< 0.05). There was no significant difference in the number of consults received (p>0.05), number of injuries sustained (p>0.05), trauma activation status (p>0.05), or need for surgery (p>0.05).

Conclusion: Military-affiliated children diagnosed with NAT experience more adverse outcomes than civilian patients. Increased LOS, complications, and mortality in military-affiliated patients suggest that these patients experience more severe life-threatening incidences of NAT at a younger age. Larger studies are required to determine the extent of these injuries in military dependents and better support families who are at risk.